SU0011568 SSNL - Laserfiche WebLink

Home Browse Search

,AOR OFFICE USE: 4 ' APPLICATION FOR SANITATION PERMIT . . ........................-......---.................. Permit No. .7.�.�. (Complete in Triplicate) .. .................... .............. _ 7-13- 26 Date Issued ..... .... .... ................................................ This Permit Expires 1 Year From Date Issued.- .. . Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein described. This application is made in compliance with County Ordinance No. 589,and existing Rules,and Regulationsr JOB ADDRESS/LOCATION ../. �jS ..,..�...��. ... .-- ....... T CT 10;!�........... US RA Owner's Name _...Q,�C?12. --P..... Z)Owx 1.5.. .. 1 +�t. � P C� �r3�..21ZZ... Address ._... ....... S --... rrcr ........ ...; ..city -....... ---------------- ............. Contractor's Name ......... n ........... P .. .. ..... '.`::.. # ..................�. Phone ................. ......--- � '2 Installation will serve: Residence Apartment House Commercial iter court Motel Q Other................'..................:....... . Number of living units------------- Number of bedrooms ............Garbage Grinder ............ Lot Size ......:.. ....tyL°r��11..� Wafer Supply: Public System and Homo .............................._....;`............_......._._......•.-..•...........................Private 444 Character of soil to a depth of 3 feet: Sand O Slit O Clay O' Peot O Sandy Loam IK cloy Loam O Hard onAdobe❑ Fill Material ............If yes,type............:.. ..... .._... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) W NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT I ) SEPTICTANK{ ] ---: No. Compartments h . .... �Q CopacitylW66-- TYPe terlal..2al ..�.._ '\ Distance to.nearest: Well ..... .. �. ... Prop. line ...7..... LEACHING LINE i ] No. of Lines ......f............... Length of each line.. _577............ Total Length ....V.. ............ 'D' Box .. Type Filter Materlai/..&7Z-. Depth Filter Material .......f......................... .Su Distance to nearest: Well Foundation ...... ............... Property Line f . [ J Depth .... Dutraeter yY-,?•.- Number ......J................... Rock Filled YesX NoC3 ....Water Table Depth ..................�...........--••---Rock ...... ! Distance to nearest: Well ... ................Foundation Prop. Line ...................... I s REPAIR/ADDITION(Prev.,Sanitation.Permit# ....r............'........................... Date _........................... .....) SepticTank (Specify Requirements) .......................... ................-...... ....:..................-...._........................................I.............. Disposal Field (Specify Requirements) -: '------ / \ ............ ..............................-.._............................------ ...................-.................... (Draw existing and required addition on reverse side) I hereby certify tho1J.have prepared this application am! that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local HeaI&DlsMct. Home owner or lk*w wed agents signature certifies the following: "I certl fy that in the performance of the work for which this permit Is issued, 1 shall not employ any person In such manner as to become pblect to Workman's Co nsation laws of California." Signed /��dC��.Q._� ........................ Owner By .. .......................... --- ---.-an -- - -.__-..... - ............... Title ......._._....._............... _ .. ....... ........ .. ........... {If other than owner) - DEP TMENT USE ONLY APPLICATION ACCEPTED BY ... . .... .... . - ..-.. S q . BUILDING PERMIT ........................... ...__...._......... _ ...DDATE ISSUED .................. 'DATE Q7..... 'ADDIITiONAI COMMENTS— fi - �:: p._.L..._,..,-...-._.-..-........... ........ .... - -------------...-----Final Inspection by: ... .. .. ................ ' Ell 13 2h 1-613 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/1b 3M i i